Hegelundmaclean6215

Spontaneous hepatitis B surface antigen (HBsAg) seroclearance, the functional cure of hepatitis B infection, occurs rarely. Prior original studies are limited by insufficient sample size and/or follow-up, and recent meta-analyses are limited by inclusion of only study-level data and lack of adjustment for confounders to investigate HBsAg seroclearance rates in most relevant subgroups. Using a cohort with detailed individual patient data, we estimated spontaneous HBsAg seroclearance rates through patient and virologic characteristics.

We analyzed 11,264 untreated patients with chronic hepatitis B with serial HBsAg data from 4 North American and 8 Asian Pacific centers, with 1,393 patients with HBsAg seroclearance (≥2 undetectable HBsAg ≥6 months apart) during 106,192 person-years. The annual seroclearance rate with detailed categorization by infection phase, further stratified by hepatitis B e antigen (HBeAg) status, sex, age, and quantitative HBsAg (qHBsAg), was performed.

The annual seroclearance rate %, but varied from close to zero to about 5% among most chronic hepatitis B subgroups, with older, male, HBeAg-negative, and genotype C patients with lower alanine aminotransferase and hepatitis B virus DNA, and qHBsAg independently associated with higher rates (see Visual Abstract, Supplementary Digital Content 2, http//links.lww.com/CTG/A367).Accidental subdural placement of spinal cord stimulator electrodes is a rare event believed to produce unreliable results, necessitating immediate removal. We report a case of a 59-year-old man with failed back surgery syndrome previously controlled with a spinal cord stimulator, who underwent spinal cord stimulator revision during which 1 lead was inadvertently advanced into the subdural space. Modified stimulation parameters achieved excellent, persistent pain relief, representing the first case of successful long-term subdural spinal cord stimulation.Vagus nerve injury may complicate carotid endarterectomy (CEA). The recurrent laryngeal nerve (RLN) branches from the vagus nerve, innervating the ipsilateral vocal cord. Vagus nerve injury can cause vocal cord dysfunction. Intraoperative vocal cord monitoring can detect vagus nerve injury during CEA. A patient with distorted neck anatomy from radiotherapy to treat oropharyngeal cancer and resultant right vocal cord paralysis required left CEA. Anticipating difficult neck dissection risking vagus nerve damage with associate RLN malfunction, we added vocal cord electromyography (EMG) to routine CEA electroencephalography (EEG). We recommend vocal cord EMG in anatomically complex CEA to avoid vagus nerve injury.Anesthesiology residents spend most of their training in operating rooms, but intraoperative teaching is often unstructured. Needs assessment indicated a need to incorporate a more evidence-based approach to education and improvement of our methods of introducing residents to primary anesthesiology literature. Kern's 6-step approach to curriculum development was used to create a robust and innovative curriculum to increase both the evidence-based component of our curriculum and the amount of educational intraoperative discussion among trainees and faculty. Our curriculum uses a structured topic outline, an e-journal club, and other relevant resources to facilitate discussion of the topics.After institutional ethics committee approval and informed consent, 20 patients with clavicle fractures were recruited. An ultrasound-guided C5 root block was performed by injecting 3 mL of 0.5% bupivacaine with a subsequent ultrasound-guided supraclavicular nerve (SCN) block with 3 mL of 0.5% bupivacaine. A combination of low-volume C5 root block and SCN block provided reliable awake anesthesia and postoperative analgesia in patients with fractured clavicles. This technique can avoid a general anesthesia for fractures of the mid and lateral clavicle. Further studies should focus on the optimal volume of local anesthetics required for the success of this technique.

Surgical patients often leave the hospital with many questions and concerns after their surgery and will contact their providers to get answers. The growth of patient-provider communication (PPC) technologies allows for many new opportunities to study postoperative patient-initiated communication. We aimed to characterize a growing body of literature on postoperative patient-initiated communication.

Review.

A scoping review methodology was used to identify 17 studies analyzing patient-initiated communication in the postoperative period and to characterize key results and areas of investigation in the literature. Patient-initiated communication in the postoperative period was defined as any communication initiated by the patient after discharge.

The majority of studies were published between 2014 and 2018 (82.4%). Telephone calls were the most common type of medium investigated (11 studies; 64.7%), followed by secure messaging (2 studies; 11.8%). Patients most commonly initiated contact regarding study results, medications, and wounds. Common areas of investigation included communication timing and sociodemographic associations.

As health systems adopt new technologies for PPC, understanding how and why patients initiate contact with providers postoperatively can inform efforts to strengthen PPC broadly. Moreover, research on sociodemographic variation in communication patterns after surgery can help address communication gaps that patient groups may experience. SLF1081851 Future research can build upon this work to improve patient outcomes and increase clinic efficiency.

As health systems adopt new technologies for PPC, understanding how and why patients initiate contact with providers postoperatively can inform efforts to strengthen PPC broadly. Moreover, research on sociodemographic variation in communication patterns after surgery can help address communication gaps that patient groups may experience. Future research can build upon this work to improve patient outcomes and increase clinic efficiency.

Continuity of patient information across settings can improve transitions after hospital discharge, but outpatient clinicians often have limited access to complete information from recent hospitalizations. We examined whether providers' timely access to clinical information through shared inpatient-outpatient electronic health records (EHRs) was associated with follow-up visits, return emergency department (ED) visits, or readmissions after hospital discharge in patients with diabetes.

Stepped-wedge observational study.

As an integrated delivery system staggered implementation of a shared inpatient-outpatient EHR, we studied 241,510 hospital discharges in patients with diabetes (2005-2011), examining rates of outpatient follow-up office visits, telemedicine (phone visits and asynchronous secure messages), laboratory tests, and return ED visits or readmissions (as adverse events). We used multivariate logistic regression adjusting for time trends, patient characteristics, and medical center and accounting for patient clustering to calculate adjusted follow-up rates.